If you talk to baby boomer gals, it seems the answer is yes. Indeed, as
millions of women enter perimenopause and then transgress to
menopause and
beyond, many say they check their sex drive at the door - and most are not happy
about it.

"I don't think a day goes by when at least one patient - and usually more -
complain that their sex drive is dropping off and want to know what they can do
about it," says Laura Corio, MD, a gynecologist and clinical instructor at Mt.
Sinai Medical Center in New York City.

Clinically known as HSDD (hypoactive sexual desire disorder) Corio says she
doesn't think more women are affected now than in the past, but she does believe
more are coming forward -- prompted, at least in part, by the success male
potency drugs like Viagra.

"The man gets a prescription for Viagra and he's ready to rock and roll while
she's thinking 'Hey, where's my pill?' If she's not ready to jump in the old van
and join him for a ride, there can be real problems," says Corio.

Discovering What's Wrong

While male sex drive is easy to define -- and relatively easy to restore --
that's often not the case for women. Because the female sex drive is
multifactorial, the desire to make love is not only influenced by physical
issues, but emotional ones as well.

"Part of the desire to make love is clearly physical, but part is also
emotional - depression can make a difference, so can any emotional issue in a
woman's life; female sex drive is very multidimensional," says Glenn D.
Braunstein, MD, an endocrinologist and chair of the department of medicine at
Cedars Sinai Medical Center in Los Angeles.

While emotions are frequently behind a loss of sex drive in younger women,
doctors say it is frequently the aging process itself that's causes changes in
desire in women over age 45.

"The very fact that a woman is no longer ovulating regularly, or not
ovulating at all, automatically takes her sex drive down a few notches," says
Steven Goldstein, MD, professor of ob-gyn and NYU Medical Center in New York
City.

Nature's Design for Sex

Indeed, as many women are aware, Mother Nature built in a natural increase in
the desire for sex beginning just prior to ovulation, and lasting several days
afterwards -- not coincidentally, the only time of the month conception is
possible.

Stop ovulating, says Goldstein, and you automatically lose that regularly
scheduled boost in your sex drive that has been present since puberty -- and
you're probably going to notice.

"There's nothing wrong with you; it's just the way nature works," says
Goldstein.

Moreover, around menopause, when there is also less
estrogen circulating in
your body, that too can bring your sex drive down for the count.

"Estrogen is a mood elevator, it works in the brain to maintain interest in
sex, but it also works at the level of the
genitals, helping to increase
sensation and just making sex more pleasurable," says Corio.

Without it, she says, not only can desire take a dive, vaginal tissue begins
to dry and shrink. As a result, intercourse can become uncomfortable, or even
painful. Problems with desire, say experts, are easy to understand.

"Who wants to make love when making love hurts?" asks Goldstein.

Moreover, he says, avoiding sex because of pain only leads to more pain. The
old "use or lose it" theory really does apply.

"From a strictly physical standpoint, the less sex you have the more painful
it is when you try to have it," he says.

Put the Sizzle in Sex

While estrogen levels are important, the latest research shows that the male
hormone testosterone also plays a role in a woman's sex drive. Though present in
only tiny amounts, some doctors say it's the seasoning that makes her sex drive
sizzle.

Moreover, when levels become erratic, as they do at midlife, that sizzle can
fizzle fast.

"There are a lot of physical reasons a woman can experience a decrease in
sexual desire. But for many women who are otherwise healthy, a drop in
testosterone that occurs at midlife is the reason," says Braunstein, who is one
of the nation's leading researchers on
testosterone treatment in women.

Complicating matters further, studies show that sometimes the very treatments
women take to control midlife symptoms -- such as
HRT or low-dose
birth control
pills -- can actually disrupt desire by robbing the body of testosterone.

"When these hormones are taken orally, they are metabolized by the liver,
which in turn puts out a protein that binds to testosterone, causing a
deficiency," says Braunstein. This, he says, can also be true for younger women
using birth control pills for contraception.

And while in younger women the answer may be to simply switch brands of birth
control pills, in women over 40, Braunstein says, adding tiny amounts of
testosterone back into the body is the solution.

But not everyone agrees. Goldstein says the jury is still out on whether it
really can help or even if it's safe. And the FDA advisory panel ruled that the
testosterone patch for women needed more safety data before approval is granted.

Still, many doctors do prescribe testosterone "off label" -- frequently
turning to drugs like Estratest, a combination estrogen-testosterone
prescription approved for hot flashes and other menopause symptoms. But if
you're at all worried about taking estrogen, experts say this is not the drug
for you.

Finding Your Mojo Again

Admittedly, there are far more options for men seeking to rediscover their
libido than there are for women trying to find theirs. In fact, despite rumors
-- and even some early clinical evidence -- that Viagra can encourage both
genders to jump in the van and head for the all-night love fest, studies show it
had disappointing results in women.

That said, the picture is not as grim as one might think. Experts WebMD
consulted suggest talking to your doctor about the following:

A blood test for low thyroid function and iron deficiency anemia,
two common disorders that can affect sex drive.

Discuss whether or not you may be suffering from low-level depression
-- which can affect libido. If you are already taking an SSRI antidepressant
drug, discuss switching to another type of medication, which won't dampen
sex drive. Some studies show that taking Viagra in this setting may improve
sexual desire.

Localized estrogen therapy. Placing estrogen directly into the
vagina soothes vaginal tissue, and allows the secretions necessary for
comfortable sex and possibly even an increase in sexual desire, says
Goldstein. Unlike oral estrogens that carry some cancer risks, he says
estrogens applied locally to the vagina are generally safe. They are
available as suppository tablets, creams, or "rings," which sit inside the
vagina and give off small doses of the hormone over time.

Compounded testosterone cream. Many compounding pharmacies (they
make medicines from scratch) offer testosterone creams and gels, but you'll
need a doctor's prescription. Corio says they can be applied to the vagina
to increase sensation, or to the clitoris to increase orgasm.

Vitamin E. When used locally in the vagina it can help rehydrate
tissue and may possibly increase sensation. No need for a prescription here;
Corio says just stick a pin in a
vitamin E capsule and apply to the vagina
several times a week, even if you're not having sex. And be sure to use a
lubricant when you are having sex - either vitamin E or a commercially
prepared product such as K-Y Jelly or Astroglide.

Zestra. A small, placebo-controlled trial published in the
Journal of Sex and Marital Therapy in 2003 showed that when used as a
genital massage oil, this proprietary blend of botanicals (including borage
seed and evening primrose oils, Angelica root and vitamins C and E) provided
a statistically significant increase in arousal, desire, genital
stimulation, ability to orgasm, and pleasure, in 20 women with or without
sexual desire problems. The treatment also worked equally well on women
using SSRI antidepressant medicines.

ArginMax. In a study of 77 women, a controlled double blind study
found the nutritional supplement ArginMax increased sexual desire and
satisfaction in more than twice the number of women taking placebo. The
research was published in the Journal of Sex and Marital Therapy in 2001.

Before using of supplements, you should first have a discussion with your
doctor as side effects or drug interactions can occur.

Don't Be Driven by Declining Sex

Drive As frustrating as a lagging
libido can be for some women, for others,
it can simply be a rite of passage to a quieter, gentler time. In fact,
Goldstein says that for many women, and their partners, a lessened sex drive is
not a problem and is often replaced by other intimate and bonding experiences.

As such, Goldstein reminds us that a reduced need for sex and a declining
drive are not medical problems -- and if they don't cause you distress, there is
no need to seek treatment.

"Just because your sex drive is different, doesn't mean there is something
wrong or that you have to try and fix it. If less sex isn't bothering you, your
partner, or your relationship, then take heart -- you are maturing in the way
nature intended," says Goldstein.